PAEZ, Circuit Judge:
Andre LeGras appeals the district court's judgment in favor of Defendants Federal Express Corporation Long Term Disability Plan and AETNA Life Insurance Company (collectively, "AETNA"). In a letter denying LeGras's application for continued long-term disability benefits, AETNA informed LeGras that he could file an internal appeal of the decision within 180 days. The 180-day period ended on a Saturday. Although LeGras mailed his appeal the following Monday, AETNA denied it as untimely. The district court dismissed LeGras's action for failure to exhaust administrative remedies. We reverse. We hold that because the last day of the appeal period fell on a Saturday, neither that day nor Sunday count in the computation of the 180 days. As LeGras mailed his notice of appeal on Monday, it was timely. This method of counting time is widely recognized and furthers the goals and purposes of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. We therefore adopt it as part of ERISA's federal common law.
In October 2008, LeGras seriously injured himself while working as a ramp transport driver for Federal Express Corporation ("FedEx"), a job he had held for twenty-three years. LeGras suffered a serious back injury that caused severe and sustained pain. Subsequent surgeries did not correct the problem. As an employee of FedEx, LeGras was a participant and beneficiary of FedEx's Long Term Disability Plan ("LTD Plan" or "Plan"). In May 2009, he began receiving disability benefits under the Plan. Subsequently, AETNA, the Plan's Claims Paying Administrator, informed LeGras that his benefits would terminate on May 24, 2011, unless he could establish that his disability qualified as a "total disability" under the LTD Plan.
After LeGras attempted to make the required showing, AETNA sent LeGras a letter explaining that the evidence he submitted did not establish that he suffered from a total disability. Of concern to AETNA was LeGras's alleged failure to prove that he could not "sit or use [his] upper extremities for sedentary work." LeGras received the letter at 1:23 p.m. on April 18, 2011. The letter stated, "[i]f you disagree with the above determination, in whole or in part, you may file a request to appeal this decision within 180 days of receipt of this notice."
The parties agree that the 180-day appeal period expired on October 15, 2011, a Saturday. LeGras mailed his appeal the following Monday. On January 17, 2012, AETNA denied LeGras's appeal as untimely. LeGras filed an action in the district court pursuant to 29 U.S.C. § 1132, the civil enforcement provision of ERISA. After answering the complaint, AETNA filed a motion for judgment on the pleadings under Federal Rule of Civil Procedure 12(c). AETNA argued that LeGras failed to exhaust his administrative remedies because he mailed his appeal after the 180-day period specified in the April 18, 2011 denial letter lapsed. The district
LeGras timely appealed.
We review de novo an order granting a motion for judgment on the pleadings under Rule 12(c). Fleming v. Pickard, 581 F.3d 922, 925 (9th Cir.2009). We accept the factual allegations in the complaint as true, and view them in a light most favorable to the plaintiff. Hoeft v. Tucson Unified Sch. Dist., 967 F.2d 1298, 1301 & n. 2 (9th Cir.1992).
The federal statute governing claims procedures under ERISA requires that "in accordance with regulations of the Secretary [of Labor], every employee benefit plan shall . . . afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim." 29 U.S.C. § 1133(2). The regulation implementing 29 U.S.C. § 1133 states that a "reasonable opportunity for a full and fair review" is "at least 180 days following receipt of a notification of an adverse benefit determination within which to appeal. . . ." 29 C.F.R. § 2560.503-1(h)(3), (h)(3)(i), (h)(4). Neither the governing statute, nor the implementing regulation, "specify a method of computing time."
Congress, in enacting ERISA, has "empowered the courts to develop, in light of reason and experience, a body of federal common law governing employee benefit plans." Menhorn v. Firestone Tire & Rubber Co., 738 F.2d 1496, 1499 (9th Cir. 1984). This federal common law "supplement[s] the explicit provisions and general policies set out in ERISA . . . governed by the federal policies at issue." Id. at 1500. One of ERISA's declared policies is to "protect the interest of [plan] participants" and to provide "adequate safeguards . . . [that are] desirable in the interests of employees." 29 U.S.C. § 1001. Indeed, we have repeatedly stated that ERISA is remedial legislation that should be construed liberally to "protect[ ] participants in employee benefits plans." McElwaine v. U.S. West, Inc., 176 F.3d 1167, 1172 (9th Cir. 1999); Batchelor v. Oak Hill Med. Grp., 870 F.2d 1446, 1449 (9th Cir.1989); Smith v. CMTA-IAM Pension Trust, 746 F.2d 587, 589 (9th Cir.1984).
There is nothing novel about the principle we adopt here that when a deadline falls on a weekend, it extends to the following business day. The Supreme Court recognized this general understanding in 1890. Street v. United States, 133 U.S. 299, 306, 10 S.Ct. 309, 33 L.Ed. 631 (1890) (". . . a power that may be exercised up to and including a given day of the month may generally, when that day happens to be Sunday, be exercised on the succeeding day"). Further, the Fifth Circuit has stated that this "rubric has universal acceptance." Armstrong v. Tisch, 835 F.2d 1139, 1140 (5th Cir.1988). LeGras faces the possibility of losing his long-term disability benefits because of a two-day difference in the computation of the time period to pursue an administrative appeal. Although the stricter time-computation method may be convenient for AETNA's purposes, it would be contrary to the purposes of ERISA to adopt a method that is decidedly protective of plan administrators, not plan participants.
Further, that a deadline extends to the next business day when it falls on a Saturday, Sunday, or holiday is widespread. For example, Federal Rule of Civil Procedure 6 ("Rule 6") states that this principle applies to "any local rule or court order, or in any statute that does not specify a method of computing time."
Incorporating this time-computation method into ERISA's federal common law protects the interests of insureds, thereby effectuating the policy goals of ERISA. Further, the concept is generally accepted and vital. See Saltarelli, 35 F.3d at 387. Therefore, we hold that, where the deadline for an internal administrative appeal under an ERISA-governed insurance contract falls on a Saturday, Sunday, or legal holiday, the period continues to run until the next day that is not a Saturday, Sunday, or legal holiday.
AETNA attempts to skirt the issue by minimizing the role that ERISA plays in our analysis of this case. It argues that LeGras's "appeal was pursuant to the . . . Plan—not ERISA or any ERISA regulation." In other words, AETNA contends that we should not apply the above time-computation method because the 180-day period for appeal is set by contract, rather than by statute or regulation. What AETNA overlooks is that the 180-day appeal period is part of ERISA's mandatory claims processing standards. As noted above, under ERISA's implementing regulations, the minimum amount of time that must be afforded to a claimant to file an administrative appeal is 180 days. 29 C.F.R. § 2560.503-1(h)(3), (h)(3)(i), (h)(4). Although the 180-day appeal period is imposed by the Plan, the Plan is ultimately governed by ERISA. Any ambiguity in calculating the 180 days should be resolved to further the purposes and goals of ERISA.
As support for its position that the LTD Plan is a private contractual arrangement and therefore should not be subject to the time-computation method we adopt, AETNA relies heavily upon a Fifth Circuit case, Jones v. Georgia Pacific Corp., 90 F.3d 114 (5th Cir.1996). In Jones, a decedent's heirs brought suit when the decedent's
Jones is distinguishable and does not support AETNA's argument. First, unlike this case, Jones did not interpret a contractual provision that was required by ERISA. In fact, the court emphasized that defendants, as offerors of a private option contract, had "full control of . . . the length of time during which the power of acceptance shall last." Id. at 117. By contrast, AETNA set the appeal period at 180 days to achieve the minimum possible compliance with a statutory and regulatory mandate. In doing so, AETNA did not "full[y] control" the length of time by which an appeal could be filed. See id. Second, the Jones court's reasoning hinged on its determination that there was no ambiguity in the contractual provision. Id. at 116. In particular, the court explained that "[t]he qualifying phrase `immediately following' can have no other meaning than the 31 days in their normal and natural sequence, without concern as to the days of the week. . . ."
Finally, AETNA warns that applying the time-computation method advocated by LeGras to the calculation of deadlines under ERISA's claims procedures would create confusion and great administrative burden. Specifically, AETNA contends that it would "put claims processors for ERISA-governed plans in the unenviable position of keeping up with all state holidays for all [fifty] states. . . ." AETNA's argument is unpersuasive. The plan administrator is responsible for identifying, and clarifying, applicable due dates in compliance with ERISA.
Although the 180-day appeal period specified in the April 18, 2011 denial letter ended on Saturday, October 15, 2011, ERISA federal common law required that AETNA accept LeGras's appeal as timely as he mailed it on the first weekday following the weekend. It was error for AETNA and the district court to conclude that LeGras's administrative appeal was untimely. We reverse and remand to the district court with directions to remand to AETNA, the Plan's Claims Paying Administrator, for consideration of LeGras's appeal.
N.R. SMITH, Circuit Judge, dissenting:
Mr. LeGras had 180 days to appeal an adverse decision from AETNA Life Insurance Company ("AETNA"), denying him long-term disability benefits under a Long Term Disability Plan ("Plan") provided by his employer, Federal Express ("FedEx"). He lost his opportunity to appeal as a result of his own conduct; he sent his appeal to AETNA two days after the appeal period expired. Even LeGras agrees that he sent his appeal two days late. To excuse LeGras's untimeliness, the majority turns a simple case of contract interpretation into an opportunity to (without precedent) expand federal common law surrounding the Employee Retirement Income Security Act ("ERISA") to rewrite private contracts. I cannot go along with them in "bailing LeGras out."
"An ERISA plan is a contract that we interpret in an ordinary and popular sense as would a person of average intelligence and experience. We look first to the explicit language of the agreement to determine, if possible, the clear intent of the parties. . . ." Harlick v. Blue Shield of Cal., 686 F.3d 699, 708 (9th Cir.2012) (internal quotation marks, citations, and alterations omitted). In general, "[c]ontract terms are to be given their ordinary meaning, and when the terms of a contract are clear, the intent of the parties must be ascertained from the contract itself." Klamath Water Users Protective Ass'n v. Patterson, 204 F.3d 1206, 1210 (9th Cir.1999). "That the parties dispute a contract's meaning does not render the contract ambiguous; a contract is ambiguous if reasonable people could find its terms susceptible to more than one interpretation." Doe 1 v. AOL LLC, 552 F.3d 1077, 1081 (9th Cir.2009) (internal quotation marks omitted).
The terms of this contract are not ambiguous. By the Plan's terms, LeGras had 180 days to file his appeal with AETNA by mail. All parties agree that LeGras received notice from AETNA that his long-term disability claim had been denied on April 18, 2011. It is also undisputed that October 15, 2011, is 180 days from the date of the notice. Where is the ambiguity? A person of average intelligence and experience would understand 180 days to mean precisely what LeGras understood it to
In other words, LeGras messed up; he failed to abide by his contract and now seeks an excuse to set aside his failure. LeGras has never offered any reason to explain why he failed to timely appeal. He could have mailed that appeal on any one of 180 days after April 18, 2011, including October 15, 2011. He offers no explanation why he did not. Post offices around the nation (even in Pocatello, Idaho) are open on Saturdays. LeGras offers no evidence to the contrary and no explanation why he did not send his appeal on that Saturday. All LeGras had to do (in order to preserve his rights) was mail the appeal within a six-month window. Instead, he flatly argues that he does not need to comply with his contract. Because the terms of the Plan are clear, the district court did not err when it dismissed LeGras's action with prejudice for failure to exhaust his administrative remedies. Our analysis should end here, with the contract.
To get around the plain terms of the contract, the majority is forced to create federal common law, in light of the ERISA regulations applicable to the Plan.
No one argues that the Plan did not comply with the ERISA regulations. Applying these regulations, the majority's logic "hits a dead end." The 180-day time limit in this case arises from the contract between LeGras, FedEx, and AETNA, and complies with the ERISA regulations. The Plan gave LeGras 180 days following receipt of the letter denying long term disability benefits to file his appeal, as the regulations outline. For that reason, LeGras never even asserted that the Plan, which incorporates the regulation's language, was in violation of ERISA or its implementing regulations. LeGras's only contentions in the district court and on appeal (prior to oral argument) were that Fed.R.Civ.P. 6 should be applied in some manner to the terms of the Plan and that AETNA breached the contract by denying his claim. In the absence of a claim that the Plan is non-conforming to the regulations, we do not
The majority declines to accept LeGras's primary contention at oral argument and on appeal: that Rule 6 should be directly applied to compute the 180-day appeal period provided in the Plan. Instead, the majority suggests we must rewrite the unambiguous terms of the Plan, a private contract between the parties, in light of the federal common law and the purpose of ERISA.
Although the majority is correct that we have used the federal common law in cases interpreting ERISA plans, we have never used it in these circumstances. This is not a case, for example, where we are called upon to determine whether common law remedies are available regarding ERISA plans. See Security Life Ins. Co. of Am. v. Meyling, 146 F.3d 1184, 1191 (9th Cir. 1998). Further, in Meyling, we importantly noted that the plan terms limited whether the common law remedy was available in that particular case. Id. at 1192; see Greany v. W. Farm Bureau Life Ins. Co., 973 F.2d 812, 822 (9th Cir.1992) ("Because the plan was unambiguous, the Greanys cannot avail themselves of the federal common law claim of equitable estoppel.").
The limiting power of unambiguous plan terms to the use of the federal common law also frames any discussion of the case that is the linchpin of the majority's holding: Saltarelli v. Bob Baker Group Medical Trust, 35 F.3d 382 (9th Cir.1994). In that case, we endorsed the "reasonable expectations" doctrine for ERISA insurance plans, id. at 387, but we never suggested (as the majority now does) that the doctrine was available to revise unambiguous plan terms where those terms did not implicate questions of coverage. The majority interprets Saltarelli to mean that it can read an insured's "reasonable expectations" into any term of an ERISA plan without limits. However, the doctrine was never intended for this purpose. Instead, the "reasonable expectations" doctrine is meant to protect insureds "regarding the
The cases that the majority cites (to support its holding that an insured's reasonable expectation that the time period to mail an appeal would not end on a Saturday) are not persuasive. In Street v. United States, 133 U.S. 299, 10 S.Ct. 309, 33 L.Ed. 631 (1890), the Supreme Court held that an executive action taken one day outside of the Congressionally mandated time frame for the officer to act was legal in part because the last day was a Sunday. Id. at 305-06, 10 S.Ct. 309. Far from recognizing any "general understanding" regarding the performance of a legal act on a weekend, Op. at 1236-37, the Supreme Court grounded its holding in the purpose of the statute and the special nature of Sunday as a holiday or a dies non. Id. at 305-07, 10 S.Ct. 309. In Armstrong v. Tisch, the Fifth Circuit decided to incorporate Rule 6 into a regulation, because the deadline could fall on a date "on which the act cannot be legally done." 835 F.2d 1139, 1140 (5th Cir.1988) (internal quotation marks omitted). The only act, that LeGras was legally required to do in order to preserve his appeal rights, was to mail a letter to AETNA. LeGras does not argue he could not legally mail a letter on a Saturday.
Similarly, the majority's reliance on Schikore v. BankAmerica Supplemental Retirement Plan, 269 F.3d 956 (9th Cir. 2001), for the proposition that we must invoke the federal common law to rewrite the terms of the Plan, is misplaced. Op. at 1236-37. In Schikore, this court held that the mailbox rule applied to litigation involving an ERISA plan. Id. at 964-65. However, the question before the Schikore court was fundamentally different than the question before us now. That difference illuminates why deploying the federal common law is inappropriate in this case. The question in Schikore was "not the interpretation of a plan term . . . but, rather, whether an evidentiary rule of federal common law is applicable in the absence of a provision in a plan rejecting that rule." Id. at 962 n. 3. The court in Schikore clearly stated that the mailbox rule "does not operate as a rule of construction." Id. at 961. The court was not tasked with construing the meaning of plan terms at all but with resolving "a critical evidentiary question: specifically, who bears the ultimate burden of establishing receipt when receipt is disputed and the evidence is inconclusive." Id. at 963. Our power to create federal common law with regard to ERISA plans was well suited to the task in Schikore. Faced with an evidentiary dispute, the court crafted a presumption to assist in the resolution of the case. However, our job in this case is decidedly different: we need only determine the meaning of 180 days within the context of the Plan. There is no dispute that LeGras failed to comply with this Plan provision.
Further, LeGras is distinguishable from the plaintiff in Schikore. We must determine, not whether LeGras complied, but
We should do the same here. The Plan terms are clear and comply in every respect with ERISA regulations. LeGras had 180 days to notify AETNA that he wanted to appeal its decision. One can only conclude that LeGras failed to abide by the clear and unambiguous terms of his contract. The analysis in this case should end there. But the majority (intent on "bailing LeGras out") unnecessarily intrudes upon the ability of the parties to enforce the terms of their negotiated private contract.
Therefore, I must respectfully dissent.